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Journal articles on the topic 'Pressurised metered dose inhaler (pMDI)'

Author: Grafiati

Published: 4 June 2021

Last updated: 15 February 2022

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1

Ding, Bo, Shahid Siddiqui, Michael DePietro, Gunilla Petersson, and Ubaldo J. Martin. "Inhaler usability of a pressurized metered dose inhaler and a soft mist inhaler in patients with COPD: A simulated-use study." Chronic Respiratory Disease 16 (July 17, 2018): 147997231878791. http://dx.doi.org/10.1177/1479972318787914.

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The objective of this study was to evaluate task performance and handling errors with soft mist inhalers (SMIs) or pressurized metered-dose inhalers (pMDIs) among patients with chronic obstructive pulmonary disease (COPD) experienced with, but not recently trained in, using these devices. This exploratory, noninterventional, simulated-use study (D5970R00004) assessed handling/usability of SMIs and pMDIs in inhaler-experienced patients with COPD (40–78 years; diagnosis ≥6 months). Patients received a device and instruction-for-use leaflet but no training and were recorded while performing tasks required for checking the device, priming, and dosing. Errors that could substantially affect the lung-delivered dose were considered critical. Sixteen of 61 patients (52% male) had used SMIs and 55 had used pMDIs. Thirty-one patients received an SMI and 30 a pMDI. Overall, 79% made ≥5 performance errors (SMI 94%; pMDI 63%) and 49% made ≥5 critical errors (SMI 68%; pMDI 30%). All patients made ≥1 error; three (all pMDI) made no critical errors. Regardless of the device used and previous inhaler experience, patient-centered training, education, and continuous retraining on correct inhaler use should be key aspects of routine patient care in COPD.

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Bryant, Linda, Christine Bang, Christopher Chew, Sae Hee Baik, and Diane Wiseman. "Adequacy of inhaler technique used by people with asthma or chronic obstructive pulmonary disease." Journal of Primary Health Care 5, no. 3 (2013): 191. http://dx.doi.org/10.1071/hc13191.

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INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are ongoing concerns to the health system. Poor inhaler technique results in less than optimal delivery of medicine to the lungs and consequent inadequate symptom control. AIM: This study aimed to assess inhaler technique amongst people with asthma and/or COPD. The secondary aims were to investigate who provided education on inhaler technique and whether age, gender or ethnicity was associated with poor inhaler technique. METHODS: People with asthma or COPD who presented to a community pharmacy with a prescription for a respiratory inhaler were invited to participate in the study. Participants completed a brief questionnaire and had their inhaler technique assessed against a standard checklist. RESULTS: There were 103 participants from 26 pharmacies, 86 with asthma and 17 with COPD. Just over half (52.5%) of the assessments indicated good inhaler technique, with 68% of people using the Turbuhaler having good technique compared to 53% for the pressurised metered dose inhaler (pMDI) with spacer and 47% for the pMDI alone. The majority of people (76%) received their initial inhaler technique instruction from their doctor. Over half of participants did not recall having their inhaler technique rechecked. DISCUSSION: After prescribing appropriate therapy, correct inhaler technique is a cornerstone of achieving adequate therapy. Rechecking inhaler technique is a gap in care that needs to be addressed from an interdisciplinary perspective. KEYWORDS: Asthma; chronic obstructive pulmonary disease; dry powder inhalers; metered dose inhalers; spacer inhalers

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Young, Paul M., and Robert Price. "Comparative Measurements of Pressurised Metered Dose Inhaler (pMDI) Stem Displacement." Drug Development and Industrial Pharmacy 34, no. 1 (January 2008): 90–94. http://dx.doi.org/10.1080/03639040701484205.

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4

Lavorini, Federico. "The Challenge of Delivering Therapeutic Aerosols to Asthma Patients." ISRN Allergy 2013 (August 5, 2013): 1–17. http://dx.doi.org/10.1155/2013/102418.

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The number of people with asthma continues to grow around the world, and asthma remains a poorly controlled disease despite the availability of management guidelines and highly effective medication. Patient noncompliance with therapy is a major reason for poor asthma control. Patients fail to comply with their asthma regimen for a wide variety of reasons, but incorrect use of inhaler devices is amongst the most common. The pressurised metered-dose inhaler (pMDI) is still the most frequently used device worldwide, but many patients fail to use it correctly, even after repeated tuition. Breath-actuated inhalers are easier to use than pMDIs. The rationale behind inhaler choice should be evidence based rather than empirical. When choosing an inhaler device, it is essential that it is easy to use correctly, dosing is consistent, adequate drug is deposited in both central and peripheral airways, and that drug deposition is independent of airflow. Regular checking of inhalation technique is crucial, as correct inhalation is one of the cornerstones of successful asthma management.

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Attar-Zadeh, Darsuh, Harriet Lewis, and Martina Orlovic. "Health-care Resource Requirements and Potential Financial Consequences of an Environmentally Driven Switch in Respiratory Inhaler Use in England." Journal of Health Economics and Outcomes Research 8, no. 2 (September 23, 2021): 46–54. http://dx.doi.org/10.36469/jheor.2021.26113.

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Background: To reduce greenhouse gas emissions, national initiatives advocate the phasing down of respiratory inhalers that use a fluorinated gas as a propellant (pressurised metered-dose inhalers [pMDI]). Nevertheless, pMDIs continue to be an effective and common choice. Objective: To assess the potential financial impact of patients with asthma or chronic obstructive pulmonary disease (COPD) switching from pMDIs to dry powder inhalers (DPIs) in a representative primary care network (PCN) population of 50 000 and the English National Health Service (NHS). Methods: Epidemiological data were combined with current inhaler use patterns to estimate the resources and costs associated with this transition, varying patient acceptance scenarios. Results: Depending on the approach, resource requirements ranged from £18 000 – £53 000 for a PCN, and from £21 – £60 million for the English NHS. Discussion: Significant funds are needed to successfully manage targeted inhaler transitions, together with counselling and follow-up appointment with an appropriately skilled clinician to assess the patient’s inhaler technique and ensure disease control. Conclusions: Targeted transition of inhalers must achieve a balance between environmental impacts, organisational factors, and patient requirements. The resources for managing a switch can be substantial but are necessary to appropriately counsel and support patients, whilst protecting the environment.

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Wong, Albert G., Paul M. O'Byrne, Christer Lindbladh, Mark D. Inman, Elisabeth Ståhl, and Frederick E. Hargreave. "Dose-response Protective Effect of Salbutamol on Methacholine Airway Responsiveness using Pressurized Metered Dose Inhalers and Turbuhalers." Canadian Respiratory Journal 5, no. 2 (1998): 119–23. http://dx.doi.org/10.1155/1998/865042.

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The purpose of this study was to estimate the relative dose potency of salbutamol Turbuhaler compared with salbutamol pressurized metered dose inhaler (pMDI) with respect to the protective effect against methacholine bronchoconstriction. Twenty-three asthmatic subjects with stable asthma participated in the study. Baseline forced expiratory volume in 1 s (FEV1) was 70% or more of predicted, and baseline methacholine provocative concentration causing a 20% fall in FEV1(PC20) was 4 mg/mL or less. The design was randomized, double-blind, double-dummy, crossover and placebo controlled and was conducted over seven study days. On each study day, the subjects inhaled 50 µg or 100 µg of salbutamol via Turbuhaler, 100 µg, 200 µg, 400 µg or 800 µg of salbutamol via pMDI, or placebo in randomized order. PC20was determined 30 mins after inhalation. Increasing doses of salbutamol pMDI increased the PC20in a dose-dependent fashion from 3.9 mg/mL after placebo to 13.3 mg/mL after pMDI 100 µg, 19.0 mg/mL after 200 µg, 32.6 mg/mL after 400 µg, and 35.1 mg/mL after 800 µg. The half-maximum response dose for pMDI (ED50) was 104 µg. Salbutamol Turbuhaler 50 µg increased the PC20to 10.0 mg/mL and 100 µg to 12.6 mg/mL. Salbutamol pMDI 200 µg provided significantly greater protection to methacholine than pMDI 100 µg or Turbuhaler 100 µg and significantly less protection than pMDI 400 µg (P<0.05). This study demonstrates that the relative protective dose potency of inhaled beta-agonists can be determined by comparing their effects on methacholine airway responsiveness. The estimated relative protective dose potency for salbutamol Turbuhaler in comparison with pMDI was 1.38 (95% CI 0.67 to 2.87) at 50 µg and was 0.96 (95% CI 0.56 to 1.64) at 100 µg.

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Ernst, Pierre. "Inhaled Drug Delivery: A Practical Guide to Prescribing Inhaler Devices." Canadian Respiratory Journal 5, no. 3 (1998): 180–83. http://dx.doi.org/10.1155/1998/802829.

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Direct delivery of medication to the target organ results in a high ratio of local to systemic bioavailability and has made aerosol delivery of respiratory medication the route of choice for the treatment of obstructive lung diseases. The most commonly prescribed device is the pressurized metered dose inhaler (pMDI); its major drawback is the requirement that inspiration and actuation of the device be well coordinated. Other requirements for effective drug delivery include an optimal inspiratory flow, a full inspiration from functional residual capacity and a breath hold of at least 6 s. Available pMDIs are to be gradually phased out due to their use of atmospheric ozone-depleting chlorofluorocarbons (CFCs) as propellants. Newer pMDI devices using non-CFC propellants are available; preliminary experience suggests these devices greatly increase systemic bioavailability of inhaled corticosteroids. The newer multidose dry powder inhalation devices (DPIs) are breath actuated, thus facilitating coordination with inspiration, and contain fewer ingredients. Furthermore, drug delivery is adequate even at low inspired flows, making their use appropriate in almost all situations. Equivalence of dosing among different devices for inhaled corticosteroids will remain imprecise, requiring the physician to adjust the dose of medication to the lowest dose that provides adequate control of asthma. Asthma education will be needed to instruct patients on the effective use of the numerous inhalation devices available.

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Lenney, J., J. A. Innes, and G. K. Crompton. "Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices." PULMONOLOGIYA, no. 4 (August 28, 2005): 80–84. http://dx.doi.org/10.18093/0869-0189-2005-0-4-80-84.

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Inefficient inhaler technique is a common problem resulting in decreased disease control and increased inhaler use. The aim of this study was to assess patients' use of different inhaler devices and to ascertain whether patient preference is indicative of ease of use and whether current inhaler use has any influence on either technique or preference. We also wished to define the most appropriate method of selecting an inhaler for a patient, taking into account observed technique and device cost. One hundred patients received instruction, in randomized order, in the use of seven different inhaler devices. After instruction they were graded (using predetermined criteria) in their inhaler technique. After assessment patients were asked which three inhalers they most preferred and which, if any, they currently used. Technique was best using the breath-actuated inhalers; the Easi-Breathe and Autohaler, with 91 % seen to have good technique. The pressurized metered dose inhaler (pMDI) fared poorly, in last position with only 79 % of patients showing good technique, despite being the most commonly prescribed. The Easi-Breathe was by far the most popular device with the patients. The Autohaler came in second position closely followed by the Clickhaler and Accuhaler. The majority of patients (55 %) currently used the pMDI but the pMDI did not score highly for preference or achieve better grades than the other devices. Only 79 % of patients tested could use the pMDI effectively even after expert instruction yet it continues to be commonly prescribed. This has important repercussions for drug delivery and hence disease control. Prescribing a patient's preferred device increases cost but can improve efficiency and therefore be cost effective in the long term. Using an inexpensive device (pMDI) when technique is good and the patient's preferred inhaler device when not is one way to optimize delivery and may even reduce cost.

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Sanders, Mark, and Ronald Bruin. "A Rationale for Going Back to the Future: Use of Disposable Spacers for Pressurised Metered Dose Inhalers." Pulmonary Medicine 2015 (2015): 1–6. http://dx.doi.org/10.1155/2015/176194.

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The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment. Despite decades of availability and healthcare support and development of teaching aids and devices to promote better use, poor pMDI user technique remains a persistent issue. The main pMDI user aid is the spacer/valved holding chamber (VHC) device. Spacer/chamber features (size, shape, configuration, construction material, and hygiene considerations) can vie with clinical effectiveness (to deliver the same dose as a correctly used pMDI), user convenience, cost, and accessibility. Unsurprisingly, improvised, low-cost alternatives (plastic drink bottles, paper cups, and paper towel rolls) have been pressed into seemingly effective service. A UK law change permitting schools to hold emergency inhalers and spacers has prompted a development project to design a low-cost, user-friendly, disposable, and recyclable spacer. This paper spacer requires neither preuse priming nor washing, and has demonstrated reproducible lung delivery of salbutamol sulphate pMDI, comparable to an industry-standard VHC, an alternative paperboard VHC, and pMDI alone. This new device appears to perform better than these other VHC devices at the low flow rates thought achievable by paediatric patients. The data suggest that this disposable spacer may have a place in the single-use emergency setting.

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10

Day, James, Michael Alexander, Michel Drouin, Charles Frankish, Jorge Mazza, William Moote, Piyush Patel, Helen Ramsdale, and William Yang. "Budesonide Aqueous Nasal Spray and Pressurized Metered Dose Inhaler in the Treatment of Adult Patients with Seasonal Allergic Rhinitis." American Journal of Rhinology 11, no. 1 (January 1997): 77–84. http://dx.doi.org/10.2500/105065897781446847.

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Budesonide, a topical corticosteroid used in the treatment of seasonal allergic rhinitis, can be administered to the nose as an aerosol via a pressurized metered dose inhaler (pMDI) or as a metered nasal pump spray. Studies have shown that about 64% (256 μg) of a nominal dose of 400 μg budesonide pMDI preparation is delivered to the patient compared with 100% of the nominal dose of the pump spray. The present study was undertaken to assess the efficacy and safety of budesonide delivered via a nasal pMDI twice daily (Rhinocort® pMDI, at 400 μg/day) with an aqueous suspension of budesonide delivered via a metered nasal pump spray once daily (Rhinocort® Aqua, at 256 μg/day or 400 μg/day). The multicenter, double-blind, randomized, placebo-controlled, parallel-group study was conducted in 318 patients (154 men, 164 women; aged 12–67 years) with ragweed-induced seasonal allergic rhinitis. A 1-week baseline period was followed by a 3-week treatment. Nasal symptoms were recorded by the patients, adverse events were noted, an overall evaluation of treatment efficacy was made, and urine cortisol and creatinine levels were measured. Substantial or total control of symptoms was achieved in 83.8% of patients treated with 256 μg of aqueous budesonide, 76.3% with 400 μg of aqueous budesonide, and 80.8% with 400 μg of budesonide pMDI; these were all significantly different (p < 0.001) compared with placebo (23.4% of patients). There were no significant differences in the 24-hour urine cortisol levels between the groups and there were few, infrequent adverse events, similar between the groups and resolved completely on discontinuation of treatment. It was concluded that budesonide, given once daily as 256 μg or 400 μg in an aqueous suspension or twice daily as 400 μg in a pMDI provides good alleviation of the symptoms of seasonal allergic rhinitis with no significant risk of suppression of urine cortisol.

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11

Bezuglaya, Elena, Nikolay Lyapunov, Vladimir Bovtenko, Igor Zinchenko, and Yurij Stolper. "Study of pressurised metered dose inhalers for the purpose of standardization of quality attributes characterizing uniformity of dosing." ScienceRise: Pharmaceutical Science, no. 4(32) (August 31, 2021): 11–23. http://dx.doi.org/10.15587/2519-4852.2021.238294.

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Aim. The purpose was to provide the rationale of test in regard to uniformity of fine particles dose for pressurised metered dose inhalers (pMDIs). Materials and methods. The pMDIs containing suspensions of salbutamol sulfate (SS) or solutions of beclometasone dipropionate (BD) were studied by laser diffraction and high performance liquid chromatography (HPLC). The particle size distribution of SS, the average dose mass and uniformity of dose mass, the average delivered dose and the uniformity of delivered dose, the average fine particles dose and uniformity of fine particles dose were determined. Apparatus A was used for assessment of fine particles dose. Results. The two analytical procedures for the quantitative determination of SS and BD by HPLC were validated in the ranges with low concentrations of these substances. The 5 medicinal products in pMDI dosage form were studied: 3 preparations were with SS and 2 ones contained BD. It was shown that three products with SS were very similar in regard to particle size distribution in containers and the average values of delivered dose were almost the same, but these products were different in the average dose mass and fine particle dose. According to the research results, the expediency of determining the average dose mass and the tests concerning uniformity of dosing of preparations by dose mass and by fine particle dose was substantiated. It was shown that in the case of pMDI the dosing of solutions of BD was more uniform compared to suspensions of SS. The approaches of leading and other pharmacopoeias concerning uniformity of dosing for pMDIs were critically discussed. The expediency of determination of uniformity of fine particle dose at the stage of pharmaceutical development was substantiated, as the therapeutic effect depends on fine particle dose. Issues concerning standardization pMDIs in regard to uniformity of fine particle dose were discussed. Conclusions. The expediency of standardization and quality control of pMDIs in regard to such attributes as the average dose mass, which characterizes the volume of the metering chamber of the valve as well as the uniformity of the dose mass and the uniformity of fine particle dose, which assure the therapeutic effect of each dose of the product was substantiated

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Van Holsbeke, C., J. Marshall, J. De Backer, and W. Vos. "P238 The Effect Of Inhalation Duration On Lung Deposition With A Pressurised Metered-dose Inhaler (pmdi)." Thorax 69, Suppl 2 (November 10, 2014): A181. http://dx.doi.org/10.1136/thoraxjnl-2014-206260.366.

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Molimard, Mathieu, Chantal Raherison, Severine Lignot, Aurelie Balestra, Stephanie Lamarque, Anais Chartier, Cecile Droz-Perroteau, Regis Lassalle, Nicholas Moore, and Pierre-Olivier Girodet. "Chronic obstructive pulmonary disease exacerbation and inhaler device handling: real-life assessment of 2935 patients." European Respiratory Journal 49, no. 2 (December 22, 2016): 1601794. http://dx.doi.org/10.1183/13993003.01794-2016.

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Acute exacerbations of chronic obstructive pulmonary disease (COPD) can be prevented by inhaled treatment. Errors in inhaler handling, not taken into account in clinical trials, could impact drug delivery and minimise treatment benefit. We aimed to assess real-life inhaler device handling in COPD patients and its association with COPD exacerbations.To this end, 212 general practitioners and 50 pulmonologists assessed the handling of 3393 devices used for continuous treatment of COPD in 2935 patients. Handling errors were observed in over 50% of handlings, regardless of the device used. Critical errors compromising drug delivery were respectively made in 15.4%, 21.2%, 29.3%, 43.8%, 46.9% and 32.1% of inhalation assessment tests with Breezhaler® (n=876), Diskus® (n=452), Handihaler® (n=598), pressurised metered-dose inhaler (pMDI) (n=422), Respimat® (n=625) and Turbuhaler® (n=420).The proportion of patients requiring hospitalisation or emergency room visits in the past 3 months for severe COPD exacerbation was 3.3% (95% CI 2.0–4.5) in the absence of error and 6.9% (95% CI 5.3–8.5) in the presence of critical error (OR 1.86, 95% CI 1.14–3.04, p<0.05).Handling errors of inhaler devices are underestimated in real life and are associated with an increased rate of severe COPD exacerbation. Training in inhaler use is an integral part of COPD management.

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Basheti, Iman, Bassam Mahboub, Laila Salameh, Mena Al-Ani, Ammar Abdulrahman Jairoun, Basema Saddik, and Eman Abu-Gharbieh. "Assessment of Novel Inhaler Technique Reminder Labels in Image Format on the Correct Demonstration of Inhaler Technique Skills in Asthma: A Single-Blinded Randomized Controlled Trial." Pharmaceuticals 14, no. 2 (February 12, 2021): 150. http://dx.doi.org/10.3390/ph14020150.

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Background: Prevalence of asthma in the United Arab Emirates (UAE) is high, and training patients on correct inhaler technique is vital. Objectives: To assess the effectiveness of inhaler technique labels incorporating the individual technique steps in image format on the retention of correct inhaler technique for patients with asthma living in the UAE and following inhaler training; secondly to investigate the effect of inhaler technique education using self-check pictorial labels on patients’ overall asthma control. Methods: This single-blinded randomized controlled study was conducted in 2019 and followed consecutive recruitment of asthma patients visiting respiratory clinics at Rashid Hospital in Dubai. Patients were using a controller inhaler (Turbuhaler (TH), Accuhaler (ACC), or pressurized metered-dose inhaler (pMDI)). Following recruitment, patients were randomized into active group receiving educational intervention plus the inhaler label, and control group receiving educational intervention without the label. Patients were assessed at baseline and at one-month on their inhaler technique and asthma control. Results: Participants (n = 245; 93 = TH, 70 = ACC, 82 = pMDI) showed a significant difference between the groups at one-month for inhaler technique scores for TH (active 5.29 ± 1.86 vs. control = 24.4 ± 21.28), ACC (active = 3.99 ± 1.43 vs. control = 25.45 ± 22.57), and pMDI (active = 4.59 ± 0.10 vs. control = 120.55 ± 17.2), p < 0.001 for all. Asthma control for active group indicated significant improvements compared to control for TH and pMDI (p < 0.001 for both), but not ACC group (p = 0.087). Conclusions: Retention of correct inhaler technique and improved asthma control can be enhanced by using a specialized inhaler technique label in image format.

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Murayama, Norihide, Kei Asai, Kikuno Murayama, Chihiro Kitatsuji, and Satoru Doi. "Deposition Dosages of Three Cromolyn Forms by Cascade Impactor." Journal of Drug Delivery 2017 (April 2, 2017): 1–6. http://dx.doi.org/10.1155/2017/1892725.

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Among inhaled asthma therapies, the present study aimed to identify factors for selecting the type of inhalation therapy for asthma. Three methods are used to deliver inhaled cromoglycate, and the airway deposition rate was evaluated using a cascade impactor with 3 dosage forms: dry powder (DP), pressurized metered dose inhaler (pMDI), and solution (jet- and mesh-types). The percentage of particles with diameters of 2–6 μm was 17.0% for the capsule, 51.8% for pMDI, 49.0% for jet-type NE-C28, and 40.4% for mesh-type NE-U22. The amounts of drug deposited in the bronchi were based on the particle distribution of the various dosage forms: 3.4 mg for the capsule, 1.0 mg for pMDI, 9.8 mg for one solution (jet-type NE-C28), and 8.1 mg for the other solution (mesh-type NE-U22). Jet-type or mesh-type electric nebulizers delivered 2-3 times more of the drug than capsules, and, compared with pMDI, 8-9 times more of the drug was deposited in the bronchi/bronchioles. Electric nebulizers are considered the best method. This study suggests that the size of particles deposited at sites of obstruction is larger than previously reported, and no obstruction of small airways occurs (<2 mm).

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Ibrahim, Wanis H., Fatima Rasul, Mushtaq Ahmad, Abeer S. Bajwa, Laith I. Alamlih, Anam M. El Arabi, Dhabia Al-Mohannadi, Mohammed Y. Siddiqui, Israa S. Al-Sheikh, and Azdin A. Ibrahim. "Errors in Aerosol Inhaler Use and Their Effects on Maternal and Fetal Outcomes among Pregnant Asthmatic Women (Subanalysis from QAKCOP Study)." Canadian Respiratory Journal 2018 (December 18, 2018): 1–8. http://dx.doi.org/10.1155/2018/7649629.

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Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient’s understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient’s cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient’s education is imperative.

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Chen, Yang, Paul M. Young, David F. Fletcher, Hak Kim Chan, Edward Long, David Lewis, Tanya Church, and Daniela Traini. "The Influence of Actuator Materials and Nozzle Designs on Electrostatic Charge of Pressurised Metered Dose Inhaler (pMDI) Formulations." Pharmaceutical Research 31, no. 5 (December 3, 2013): 1325–37. http://dx.doi.org/10.1007/s11095-013-1253-7.

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Tong, H. J., C. Fitzgerald, P. J. Gallimore, M. Kalberer, M. K. Kuimova, P. C. Seville, A. D. Ward, and F. D. Pope. "Rapid interrogation of the physical and chemical characteristics of salbutamol sulphate aerosol from a pressurised metered-dose inhaler (pMDI)." Chem. Commun. 50, no. 98 (October 6, 2014): 15499–502. http://dx.doi.org/10.1039/c4cc05803h.

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Muhammad Faqhrurrazi Abd Rahman, Suzairin MD Seri, Nor Zelawati Asmuin, Ishkrizat Taib, and Nur Syakirah Rabiha Rosman. "Response Surface Methodology (RSM) Approach for Optimizing the Actuator Nozzle Design of Pressurized Metered-Dose Inhaler (pMDI)." CFD Letters 13, no. 7 (July 25, 2021): 27–44. http://dx.doi.org/10.37934/cfdl.13.7.2744.

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Recently, a remarkable scientific interest in the inhalation therapy for respiratory disease was spiked attributed to the growing prevalence of asthma, chronic obstructive pulmonary disease (COPD), and coronavirus disease 2019 (COVID-19) pandemic. A pressurized metered-dose inhaler (pMDI) is the best option by providing fast and efficient symptomatic relief within the lung. However, the rapid development of new inhalation devices could be critical in this competitive environment, and optimizing the inhalation devices could be costly and time-consuming. Therefore, the computational fluid dynamic (CFD) approach was used to shorten the development time. In this study, response surface methodology (RSM) in ANSYS version 19.2 was introduced to discover the optimal design for the actuator nozzle to increase the performance of pMDI. Three (3) parameters (orifice diameter, length, and actuator angle) were optimized, and the best design was selected according to the analysis of particle tracking. The analysis of spray plume was also conducted and compared to analyze the spray plume characteristic produced by three designs. The result showed that RSM generated three (3) models for the new design of the actuator nozzle (Design A, Design B, and Design C). Among three (3) designs, actuator nozzle design C showed the highest injection particle number (232457) and the only one that produced maximum particles velocity magnitude in the acceptable ranges (35.67m/s). All three designs showed a similar pattern as maximum particle velocity magnitude decreased along the axial length until they match the air velocity (0.03-0.04 m/s). Furthermore, the spray plume length, angle, and width were observed to increase linearly with the decreasing maximum particle velocity magnitude. Thus, this study suggested that design C might have the potential as a new actuator nozzle to develop future pMDI to relieve the respiratory condition.

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Ohbayashi, Hiroyuki, Takamitsu Asano, Sahori Kudo, and Mitsue Ariga. "Comparison of User Satisfaction and Preference with Inhalant Devices Between a Pressurized Metered-Dose Inhaler and Ellipta in Stable Asthma Patients: A Randomized, Crossover Study." Pulmonary Therapy 7, no. 1 (March 2, 2021): 171–87. http://dx.doi.org/10.1007/s41030-021-00149-6.

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Abstract Introduction Inhalation therapy involves two types of adherence: adherence to the drug and adherence to the procedures for the inhalation device. User satisfaction and preference are key factors for maintaining good adherence of both types, and they should be evaluated based on three conditions being well maintained: asthma control level (ACL), adherence, and adequate device operability during usage duration. We compared user satisfaction and preference between a pressurized metered-dose inhaler (pMDI) and a dry powder inhaler (Ellipta), while maintaining the three conditions during usage in stable asthma patients. Methods In this open-label, randomized, two-way crossover study, patients with stable asthma [Asthma Control Questionnaire (ACQ) scores < 0.75] were classified into a 20–64-year age group (G1) and a ≥ 65-year age group (G2) and randomly assigned to either a formoterol/fluticasone combination (FFC) as the pMDI group or a vilanterol/fluticasone combination (VFC) as the Ellipta group. Satisfaction and preference levels were evaluated at week 4. ACL was measured using the ACQ and Japan Asthma Control Survey questionnaires at weeks 0 and 4. Device operability and respiratory resistance were also examined. Results Forty-four patients (23 G1, age 45.8 ± 1.9 years; 21 G2, 74.1 ± 1.3 years) were enrolled and maintained good ACL during the study. Adherence to FFC pMDI and VFC Ellipta was > 97% in all groups. Device operability did not differ significantly between FFC pMDI and VFC Ellipta in the G1 (p = 0.189) or G2 (p = 0.506) group. Overall satisfaction was marginally higher with the FFC pMDI than with the VFC Ellipta in G2 (p = 0.012) but non-significantly different in G1 (p = 0.733). Factors affecting overall satisfaction in G2 were difference of inhalation device and body mass index. Respiratory resistance did not change significantly over the study in G2. Conclusion Based on maintaining good ACL, adherence, and device operability, FFC pMDI showed significantly higher satisfaction and preference levels than VFC Ellipta in elderly persons. Trial Registration Japan Registry of Clinical Trials identifier, jRCTs041180001 (registered 21 August 2018).

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Ntalianis, Vaggelis, Nikos Dimitris Fakotakis, Stavros Nousias, Aris S. Lalos, Michael Birbas, Evangelia I. Zacharaki, and Konstantinos Moustakas. "Deep CNN Sparse Coding for Real Time Inhaler Sounds Classification." Sensors 20, no. 8 (April 21, 2020): 2363. http://dx.doi.org/10.3390/s20082363.

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Effective management of chronic constrictive pulmonary conditions lies in proper and timely administration of medication. As a series of studies indicates, medication adherence can effectively be monitored by successfully identifying actions performed by patients during inhaler usage. This study focuses on the recognition of inhaler audio events during usage of pressurized metered dose inhalers (pMDI). Aiming at real-time performance, we investigate deep sparse coding techniques including convolutional filter pruning, scalar pruning and vector quantization, for different convolutional neural network (CNN) architectures. The recognition performance has been assessed on three healthy subjects following both within and across subjects modeling strategies. The selected CNN architecture classified drug actuation, inhalation and exhalation events, with 100%, 92.6% and 97.9% accuracy, respectively, when assessed in a leave-one-subject-out cross-validation setting. Moreover, sparse coding of the same architecture with an increasing compression rate from 1 to 7 resulted in only a small decrease in classification accuracy (from 95.7% to 94.5%), obtained by random (subject-agnostic) cross-validation. A more thorough assessment on a larger dataset, including recordings of subjects with multiple respiratory disease manifestations, is still required in order to better evaluate the method’s generalization ability and robustness.

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Subramani, Parasuraman Aiya, and Venkata R. Narala. "Challenges of Curcumin Bioavailability: Novel Aerosol Remedies." Natural Product Communications 8, no. 1 (January 2013): 1934578X1300800. http://dx.doi.org/10.1177/1934578x1300800129.

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Nanoparticles are promising aids for drug delivery for previously challenging diseases, and many incurable ones. Curcumin (diferuloylmethane) is a pleiotropic molecule having various target molecules in the body. Despite its effects, curcumin-based drugs are not readily available in the market because of their low bioavailability. Although dietary intake and knowledge about the potential of curcumin are high in countries like India, studies indicate that the bioavailability problem still persists. However, administration of curcumin through inhalation has received little consideration. In this review we discuss the potential of curcumin, approaches made to overcome the bioavailability challenges, and novel approaches that could be applied in order to deliver curcumin in a pressurized metered dose inhaler (pMDI).

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Watanabe, Takuro, Takumu Hattori, Kouji Maeda, Sousuke Tukamoto, and Hiroshi Tobata. "Research and development of the inspiration timing evaluation system in the pressurized metered dose inhaler(pMDI)." Iryou kikigaku (The Japanese journal of medical instrumentation) 84, no. 5 (2014): 543–49. http://dx.doi.org/10.4286/jjmi.84.543.

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Brown, Randall, Lanny Rosenwasser, Tom Uryniak, Ubaldo Martin, and James Zangrilli. "Response to Budesonide/Formoterol Pressurized Metered-Dose Inhaler (BUD/FM pMDI) by Asthma Severity in 2 Populations." Chest 140, no. 4 (October 2011): 238A. http://dx.doi.org/10.1378/chest.1118291.

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Mezzanotte, W. S., C. J. Miller, and S. Senn. "Comparative Bronchodilatory Effects of Formoterol Dry-Powder Inhaler (DPI) Versus the Combination of Formoterol and Budesonide Pressurized Metered-Dose Inhaler (pMDI)." Journal of Allergy and Clinical Immunology 119, no. 1 (January 2007): S248. http://dx.doi.org/10.1016/j.jaci.2006.12.339.

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HAMPELJR, F., P. MARTIN, and W. MEZZANOTTE. "Early Bronchodilatory Effects of Budesonide/Formoterol Pressurized Metered-Dose Inhaler (pMDI) Compared With Fluticasone Propionate/Salmeterol Dry Powder Inhaler (DPI) and Albuterol pMDI in Adults With Asthma." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S220—S221. http://dx.doi.org/10.1016/j.jaci.2007.12.872.

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O'Brien, C. D., T. Uryniak, and J. Zangrilli. "Pulmonary Function and Gender in Patients With Persistent Asthma Treated With Budesonide/Formoterol Pressurized Metered-Dose Inhaler (pMDI)." Journal of Allergy and Clinical Immunology 125, no. 2 (February 2010): AB68. http://dx.doi.org/10.1016/j.jaci.2009.12.267.

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Cocks, Elizabeth, Satyanarayana Somavarapu, Oya Alpar, and David Greenleaf. "Influence of Suspension Stabilisers on the Delivery of Protein-Loaded Porous Poly (DL-Lactide-co-Glycolide) (PLGA) Microparticles via Pressurised Metered Dose Inhaler (pMDI)." Pharmaceutical Research 31, no. 8 (February 19, 2014): 2000–2009. http://dx.doi.org/10.1007/s11095-014-1302-x.

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NAKAGAWA, Kazuto, Fujio KOEDA, and Reiko ITO. "Monitoring of Inhalation Using a Pressurized Metered-dose Inhaler (pMDI) Fitted with a Differential Pressure Sensor and Its Applications in Inhaler Technique Training." Proceedings of Mechanical Engineering Congress, Japan 2019 (2019): J24102. http://dx.doi.org/10.1299/jsmemecj.2019.j24102.

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Kaiser, H. B., C. J. Miller, and L. O'Dowd. "Measured Onset of Bronchodilation With Budesonide and Formoterol Administered via One Pressurized Metered-dose Inhaler (pMDI) in Patients With Asthma Previously Receiving Inhaled Corticosteroids." Journal of Allergy and Clinical Immunology 119, no. 1 (January 2007): S249. http://dx.doi.org/10.1016/j.jaci.2006.12.342.

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Delestre-Levai, Irisz, Jorg Taubel, Anne Tulard, Andrea Vele, Massimo Cella, and George Georges. "ETHNIC SENSITIVITY STUDY OF THE EXTRA-FINE SINGLE-INHALER TRIPLE THERAPY BECLOMETHASONE DIPROPIONATE/FORMOTEROL FUMARATE/GLYCOPYRRONIUM BROMIDE (BDP/FF/GB) PRESSURISED METERED DOSE INHALER (PMDI) IN HEALTHY JAPANESE AND CAUCASIAN SUBJECTS." Chest 158, no. 4 (October 2020): A1862—A1863. http://dx.doi.org/10.1016/j.chest.2020.08.1617.

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Ahookhosh, Kaveh, Maysam Saidi, Mousa Mohammadpourfard, Habib Aminfar, Hamed Hamishehkar, Ali Farnoud, and Otmar Schmid. "Flow Structure and Particle Deposition Analyses for Optimization of a Pressurized Metered Dose Inhaler (pMDI) in a Model of Tracheobronchial Airway." European Journal of Pharmaceutical Sciences 164 (September 2021): 105911. http://dx.doi.org/10.1016/j.ejps.2021.105911.

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Corren, J., P. E. Korenblat, C. J. Miller, C. D. O'Brien, and W. S. Mezzanotte. "Comparative Assessment of Asthma Control With Budesonide and Formoterol in One Pressurized Metered-Dose Inhaler (pMDI) Versus Budesonide and Formoterol in Individual Inhalers and Placebo." Journal of Allergy and Clinical Immunology 119, no. 1 (January 2007): S248. http://dx.doi.org/10.1016/j.jaci.2006.12.340.

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OPPENHEIMER, J., E. KERWIN, C. LAFORCE, C. MILLER, L. ODOWD, and M. GOLDMAN. "Asthma Control with Once-Daily (qd) Budesonide/Formoterol Pressurized Metered-Dose Inhaler (pMDI) in Adults and Adolescents with Asthma Previously Stable with Twice-Daily (bid) Budesonide/Formoterol pMDI." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S8. http://dx.doi.org/10.1016/j.jaci.2007.12.035.

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NAKAGAWA, Kazuto, Fujio KOEDA, and Reiko ITO. "Monitoring of Inhalation Using a Pressurized Metered-dose Inhaler (pMDI) Fitted with a Differential Pressure Sensor and Its Applications in Inhalation Therapy." Proceedings of Mechanical Engineering Congress, Japan 2018 (2018): J1630202. http://dx.doi.org/10.1299/jsmemecj.2018.j1630202.

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Mitchell, J. P., and M. W. Nagel. "An Assessment of the API Aerosizer® for the Real-Time Measurement of Medical Aerosols from Pressurized Metered-Dose Inhaler (pMDI) Systems." Aerosol Science and Technology 25, no. 4 (January 1996): 411–23. http://dx.doi.org/10.1080/02786829608965406.

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LEFLEIN, J., W. BERGER, T. URYNIAK, P. VERVAET, L. ODOWD, and C. OBRIEN. "Long-term Safety and Systemic Effects of Budesonide and Formoterol Administered via One Pressurized Metered-Dose Inhaler (pMDI) in Children With Asthma." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S155. http://dx.doi.org/10.1016/j.jaci.2007.12.570.

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Meltzer, S. M., S. L. Spector, T. Uryniak, and U. J. Martin. "Response to Budesonide/Formoterol Pressurized Metered-Dose Inhaler (BUD/FM pMDI) by Patient's Sex in Non-Black and Black Populations With Asthma." Journal of Allergy and Clinical Immunology 127, no. 2 (February 2011): AB160. http://dx.doi.org/10.1016/j.jaci.2010.12.636.

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39

Dunlop, William, Louise Heron, Georgia Fox, and Maire Greaney. "Budget Impact Analysis of a Fixed-Dose Combination of Fluticasone Propionate and Formoterol Fumarate (FP/FORM) in a Pressurized Metered-Dose Inhaler (pMDI) for Asthma." Advances in Therapy 30, no. 10 (October 2013): 933–44. http://dx.doi.org/10.1007/s12325-013-0062-z.

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McIvor, R. Andrew, Hollie M. Devlin, and Alan Kaplan. "Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers." Canadian Respiratory Journal 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/5076259.

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Valved holding chambers (VHCs) have been used with pressurized metered-dose inhalers since the early 1980s. They have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce side effects such as throat irritation, dysphonia, and oral candidiasis that are common with use of pressurized metered-dose inhalers (pMDIs) alone. VHCs act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a two-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. The design of VHC devices can have an impact on performance. Features such as antistatic properties, effective face-to-facemask seal feedback whistles indicating correct inhalation speed, and inhalation indicators all help improve function and performance, and have been demonstrated to improve asthma control, reduce the rate of exacerbations, and improve quality of life. Not all VHCs are the same, and they are not interchangeable. Each pairing of a pMDI device plus VHC should be considered as a unique delivery system.

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Brown, Randall, Tom Uryniak, Ajay Aggarwal, and Ubaldo Martin. "Response to Budesonide/Formoterol Pressurized Metered-Dose Inhaler (BUD/FM pMDI) by Body Mass Index (BMI) and Patient's Sex in Patients With Asthm." Chest 140, no. 4 (October 2011): 233A. http://dx.doi.org/10.1378/chest.1118278.

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Shah, S. R., W. W. Busse, J. McElhattan, C. D. O'Brien, and M. Goldman. "Efficacy and Tolerability of Fixed-Dose (FD) and Adjustable-Dose (AD) Budesonide/Formoterol Pressurized Metered-Dose Inhaler (BUD/FM pMDI) and FD Fluticasone Propionate/Salmeterol Dry Powder Inhaler (FP/SAL DPI) Within Racial Groups." Journal of Allergy and Clinical Immunology 123, no. 2 (February 2009): S80. http://dx.doi.org/10.1016/j.jaci.2008.12.278.

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Davidson, N., H. J. Tong, M. Kalberer, P. C. Seville, A. D. Ward, M. K. Kuimova, and F. D. Pope. "Measurement of the Raman spectra and hygroscopicity of four pharmaceutical aerosols as they travel from pressurised metered dose inhalers (pMDI) to a model lung." International Journal of Pharmaceutics 520, no. 1-2 (March 2017): 59–69. http://dx.doi.org/10.1016/j.ijpharm.2017.01.051.

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Murphy, Kevin R., Rajiv Dhand, Frank Trudo, Tom Uryniak, and Ajay Aggarwal. "Therapeutic Equivalence Of Budesonide/Formoterol (BUD/FM) Breath-Actuated Inhaler (BAI) Compared With Bud/FM Pressurized Metered-Dose Inhaler (pMDI) In Adults and Adolescents With Moderate To Severe Asthma." Journal of Allergy and Clinical Immunology 133, no. 2 (February 2014): AB1. http://dx.doi.org/10.1016/j.jaci.2013.12.027.

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45

PETERS, S., L. ROSENWASSER, P. VERVAET, and C. OBRIEN. "Cardiac Safety of Budesonide (BUD)/Formoterol (FM) Pressurized Metered-Dose Inhaler (pMDI): Pooled Data From Clinical Studies of Children, Adolescents, and Adults With Asthma." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S155. http://dx.doi.org/10.1016/j.jaci.2007.12.568.

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LAFORCE, C., E. KERWIN, J. OPPENHEIMER, C. MILLER, P. VERVAET, L. ODOWD, and M. GOLDMAN. "Safety of Once-Daily (qd) Budesonide and Formoterol Administered via One Pressurized Metered-Dose Inhaler (pMDI) in Adults and Adolescents With Asthma Previously Stable With Twice-Daily (bid) Budesonide/Formoterol pMDI." Journal of Allergy and Clinical Immunology 121, no. 2 (February 2008): S153. http://dx.doi.org/10.1016/j.jaci.2007.12.562.

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Levy, Mark L., Alison Hardwell, Eddie McKnight, and John Holmes. "Asthma patients' inability to use a pressurised metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the Global Initiative for Asthma (GINA) strategy: a retrospective analysis." Primary Care Respiratory Journal 22, no. 4 (September 16, 2013): 406–11. http://dx.doi.org/10.4104/pcrj.2013.00084.

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Spector, Sheldon L., Christopher D. O’ Brien, Tom Uryniak, and Ubaldo J. Martin. "Safety and Tolerability of a Budesonide/Formoterol (BUD/FM) Pressurized Metered-Dose Inhaler (pMDI) in Black Adolescents and Adults With Moderate to Severe Persistent Asthma." Chest 138, no. 4 (October 2010): 705A. http://dx.doi.org/10.1378/chest.10079.

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Rosenwasser, L. J., M. J. Noonan, P. Martin, L. O'Dowd, and C. D. O'Brien. "Safety of Budesonide and Formoterol Administered Via One Pressurized Metered-dose Inhaler (Budesonide/Formoterol pMDI) in Patients (≥12 Years) With Moderate to Severe Persistent Asthma." Journal of Allergy and Clinical Immunology 119, no. 1 (January 2007): S5. http://dx.doi.org/10.1016/j.jaci.2006.11.035.

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NAKAGAWA, Kazuto, Fujio KOEDA, and Reiko ITO. "Monitoring of Inhalation Using a Pressurized Metered-dose Inhaler (pMDI) Fitted with a Differential Pressure Sensor and Its Applications to Its Applications to Automatic Spraying." Proceedings of Mechanical Engineering Congress, Japan 2020 (2020): J16309. http://dx.doi.org/10.1299/jsmemecj.2020.j16309.

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